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NPI Code Detail

MEDICARE: CHC - ROSWELL NURSING & REHAB CTR, LLC

MEDICARE: CHC - ROSWELL NURSING & REHAB CTR, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility10601756GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336145424
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHC - ROSWELL NURSING & REHAB CTR, LLC
Provider Business Mailing Address
First Line : 1109 GREEN ST
Second Line :
City : ROSWELL
State : GA
Zip : 30075-3609
Country : US
Telephone Number : 770-998-1802
Fax Number : 770-518-8144
Provider Business Practice Location Address
First Line : 1109 GREEN ST
Second Line :
City : ROSWELL
State : GA
Zip : 30075-3609
Country : US
Telephone Number : 770-998-1802
Fax Number : 770-518-8144
Authorized Official
Title or Position : MANAGER
Name : MR. MITCHELL STARER
Credential :
Telephone Number : 914-390-4300
Provider Enumeration Date : 06/23/2005
Last Update Date : 03/21/2014

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